The Impact of an International Interprofessional Experience on Perceptions of Pharmacist-Physician Relationships

Objective. To assess the impact of this international interprofessional learning experience on perceptions of pharmacist-physician relationships and interprofessional teams. Methods. Medical and pharmacy students completed a one-week interprofessional medical mission experience in the Dominican Republic. Anonymous surveys were administered to 17 students before and after completion to measure perceptions of pharmacist-physician relationships and interprofessional teams. Responses were matched and changes in perceptions were analyzed using the Wilcoxon Signed Rank test. The SPICE-R2 instrument was administered after the experience to measure attitudes toward interprofessional teams. Results. Of the 17 participants, 100% responded to all surveys. Significant improvements were seen in the perception of pharmacists as an integral part of medical mission trips (P=0.035) and confidence in the ability to communicate with other healthcare disciplines (P=0.033). All students stated they would recommend this experience, and agreed that interprofessional experiences enhance their team work skills and should be incorporated into their education. Student comments supported that this was a meaningful and effective interprofessional experience. The results of the SPICE-R2 demonstrated positive attitudes about interprofessional teams, with all questions having a median score of “agree” or “strongly agree.” Conclusions. An international interprofessional experience improved the perception of pharmacist-physician relationships. The experience provided understanding of the other healthcare discipline, an appreciation for the importance of interprofessional teamwork, increased student confidence in communicating with the other discipline, and cultivated interest in future interprofessional collaboration

Doing the Work -- Collectively Pursuing Anti-Racist and Equitable Teaching: One High School English Department’s Journey

Our district has long been heralded as a beacon school, one that delivers exceptional education in an exceptional community. Peeling back the layers, however, revealed a district that lurched towards the traditional, even with the hiring of DEI faculty and the step away from an historical indigenous mascot. In a time where teachers are exhausted and afraid of community backlash, our English department dared to tear off the scabs of old wounds and united to push toward what is best for our changing community and students. Hard conversations, difficult topics, and months of legwork at last successfully provided the impetus to move our department forward. As we dug into our curriculum and dug out of our individual comfort zones and passion projects, we realized that we had a long way to go to truly provide an education for our students that was representative of the students in the room and inclusive of all. Haltingly, we began to revamp our curriculum and unite in our goals. Along the way, we found ways to build bridges between old and new staff members, and ultimately joined together to write this article to submit for publication. This article unpacks our individual and collective journeys toward cohesion and inclusion, outlines our inquiry work to “stretch the field of literacy, language arts, and English” in our district, discusses the “tensions [that we] see in literacy education today,” and details our work to “best meet the needs of [our] students” (Language Arts Journal of Michigan, 2021). The work has been and continues to be difficult, but it is critically important—and worth it

Limits to reproduction and seed size-number trade-offs that shape forest dominance and future recovery

International audienceThe relationships that control seed production in trees are fundamental to understanding the evolution of forest species and their capacity to recover from increasing losses to drought, fire, and harvest. A synthesis of fecundity data from 714 species worldwide allowed us to examine hypotheses that are central to quantifying reproduction, a foundation for assessing fitness in forest trees. Four major findings emerged. First, seed production is not constrained by a strict trade-off between seed size and numbers. Instead, seed numbers vary over ten orders of magnitude, with species that invest in large seeds producing more seeds than expected from the 1:1 trade-off. Second, gymnosperms have lower seed production than angiosperms, potentially due to their extra investments in protective woody cones. Third, nutrient-demanding species, indicated by high foliar phosphorus concentrations, have low seed production. Finally, sensitivity of individual species to soil fertility varies widely, limiting the response of community seed production to fertility gradients. In combination, these findings can inform models of forest response that need to incorporate reproductive potential

Limits to reproduction and seed size-number tradeoffs that shape forest dominance and future recovery

The relationships that control seed production in trees are fundamental to understanding the evolution of forest species and their capacity to recover from increasing losses to drought, fire, and harvest. A synthesis of fecundity data from 714 species worldwide allowed us to examine hypotheses that are central to quantifying reproduction, a foundation for assessing fitness in forest trees. Four major findings emerged. First, seed production is not constrained by a strict trade-off between seed size and numbers. Instead, seed numbers vary over ten orders of magnitude, with species that invest in large seeds producing more seeds than expected from the 1:1 trade-off. Second, gymnosperms have lower seed production than angiosperms, potentially due to their extra investments in protective woody cones. Third, nutrient-demanding species, indicated by high foliar phosphorus concentrations, have low seed production. Finally, sensitivity of individual species to soil fertility varies widely, limiting the response of community seed production to fertility gradients. In combination, these findings can inform models of forest response that need to incorporate reproductive potential

Invisible Information, Unseen Connections: An Exploration of the Hidden Relationships that can Shape Data

Datasets often reflect complex and nuanced relationships which can be difficult to detect or fully represent with traditional epidemiological methods. This may be problematic as it can hinder further analyses, or give the investigator an incomplete picture of the outcome being studied. In this dissertation I explored three analytic contexts in which important relationships can go undetected and examined several methods that can be used to ascertain hidden or latent relationships in the data, drawing from meta-regression, latent class analysis, network analysis, and transmission modeling. In Aim 1, we used meta-regression to ascertain how the association between individual wealth, country level wealth, and Human Immunodeficiency Virus (HIV) burden has changed over time across a set of Sub-Saharan African (SSA) Countries. It has been assumed that like, The West, HIV is also a disease of poverty in SSA. However newer research suggests that this assumption may not be true. Here, we show that HIV may be positively associated with wealth in urban but not rural contexts, and that this association has waned over time. Aim 2 identifies patterns of sexual behavior and substance use across the life course, and examines the association between these patterns and sexually transmitted infection risk. Risk factors for sexually transmitted infections have proven challenging to study due to their tendency to be highly correlated or even collinear with one another. This collinearity is problematic because it inhibits the ability of statistical software to detect the effect of covariates in a regression model, rendering the coefficients of the variables uninformative. Consequently, alternative approaches are needed in order to identify behaviors that put individuals at risk for infection. This aim uses Latent Class Analysis which, unlike regression, uses collinearity to its advantage to identify response patterns. Our results reveal the existence of 5 archetypes that serve as the basis for the profiles present across our four age strata. However, the exact composition of each strata’s profiles varies in the magnitude that particular behaviors are endorsed, which we attribute to a combination of age, period, and cohort effects. Aim 3 constitutes the first part of a two-part analysis that uses network methodology to characterize and quantify patient movement and disease transmission. In this aim, a descriptive analysis of network structure was undertaken to describe the underlying interrelationship between hospital units and patient movement, using patient transfer data from the University Hospital at Michigan Medicine. We then characterized the resulting network to understand key structural features, including node centrality, graph centralization, degree distributions, and community structure. As a network, University Hospital is decentralized but highly transitivity . In Aim 4 we used an SEIR compartmental model to simulate COVID-19 in a hospital setting, to examine the relationship between the hospital network structure and disease transmission dynamics. The purpose of this analysis was to illustrate how the network relationship between locations can be an underlying structure that informs transmission dynamics within the hospital. In summary, the chapters of this dissertation illustrate contexts in which latent variable associations exist in data and provide tools researchers can use to extract them. It is our hope that this work provokes thought and sparks new lines of inquiry.PHDEpidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/175668/1/ecandrus_1.pd

Has the relationship between wealth and HIV risk in Sub-Saharan Africa changed over time? A temporal, gendered and hierarchical analysis

This study examines the relationship between wealth and HIV infection in Sub-Saharan Africa to determine whether and how this relationship has varied over time, within and across countries, by gender, and urban environment. The analysis draws on DHS and AIS data from 27 Sub-Saharan African countries, which spanned the 14 years between 2003 and 2016. We first use logistic regression analyses to assess the relationship between individual wealth, HIV infection and gender by country and year stratified on urban environment. We then use meta-regression analyses to assess the relationship between country level measures of wealth and the odds of HIV infection by gender and individual level wealth, stratified on urban environment. We find that there is a persistent and positive relationship between wealth and the odds of HIV infection across countries, but that the strength of this association has weakened over time. The rate of attenuation does not appear to differ between urban/rural strata. Likewise, we also find that these associations were most pronounced for women and that this relationship was persistent over the study period and across urban and rural strata. Overall, our findings suggest that the relationship between wealth and HIV infection is beginning to reverse and that in the coming years, the relationship between wealth and HIV infection in Sub-Saharan Africa may more clearly mirror the predominant global picture

A 7000-Year Record of Floods and Ecological Feedbacks In Weeks Bay, Alabama, USA

Climate change, sea-level rise, and human activities present major concerns for coastal environments. Paleoenvironmental records allow us to extend the instrumented record and study recent environmental impacts in a long-term context with natural pre-industrial conditions. Here, we investigate grain size, stable carbon (δ13C) and nitrogen (δ15N) isotopes, elemental composition, and diatom abundance in sediments to construct a 7000-year paleoenvironmental history of Weeks Bay, Alabama, a NOAA National Estuarine Research Reserve. Four major floods of the Fish River since 1986 CE are independently identified in the Weeks Bay sediment record, validating the bay setting as an archive of flood events. Thirty-four flood events were identified over the last 5000 years, with two periods of intense flood activity coinciding with the Medieval Climate Anomaly and the Little Ice Age, indicating association of relatively short-term climate events and enhanced storm activity. Further, multiple paleoenvironmental proxies indicate marine conditions during formation of the bay ~6600 calendar years Before Present (cal yr BP) and a brackish transition as the estuary became restricted ~2000 cal yr BP. High total organic carbon/nitrogen values indicate nitrogen limitation in Weeks Bay. Increase in organic content, diatoms, and redox- and nutrient-associated elemental proxies over the last 300 years, with dramatic increase in algal abundance since the 1980s, strongly suggest that human activities (i.e. land clearing, agriculture) increased ecological feedbacks in the bay. Comparing past and present environmental conditions of coastal estuaries advances our understanding of estuarine response to climate change and sea level, floods, and human activities, which is important for environmental management and wetland conservation policy

NOTES Dried Blood Spots versus Sera for Detection of Rubella Virus-Specific Immunoglobulin M (IgM) and IgG in Samples Collected during a Rubella Outbreak in Peru of rubella virus-specific IgM and IgG results for serum/DBS sample pairs for persons with sus

Most persons with rubella virus-specific immunoglobulin M (IgM)-or IgG-positive sera tested positive (98% [n ‫؍‬ 178] and 99% [n ‫؍‬ 221], respectively) using paired filter paper dried blood spot (DBS) samples, provided that DBS indeterminate results were called positive. For persons with IgM-or IgG-negative sera, 97% and 98%, respectively, were negative using DBS. Simplification of specimen collection, storage, transport, and processing in the field would be a great advantage to rubella surveillance. Recent studies have suggested that filter paper dried blood spots (DBS) are suitable for laboratory detection of measles-specific immunoglobulin M (IgM) The presence of rubella virus-specific IgM in serum according to enzyme immunoassay is diagnostic for rubella, and thus, results from sera were used as the standard. However, because most specimens were collected in the first week after rash onset, a time period when serum IgM and IgG enzyme immunoassays do not detect many rubella cases, we do not refer to serum samples as a "gold standard" (1, 9). Health care workers at the local health care centers in five Regional Health Directorates in Peru enrolled persons 8 months or more in age seen within 28 days of rash and fever onset (clinically suspected rubella). Persons who were vacci-* Corresponding author. Mailing address: Centers for Disease Control and Prevention